Preterm birth, low birthweight and the stressfulness of the household role for pregnant women

Whilst there is substantial, if inconclusive, literature on the association between psychosocial factors and birth outcomes, the relationship between persistent stressful aspects of daily life and birth outcomes has not been studied. This paper reports on the association of preterm birth and low birthweight with the psychosocial stresses of the household role. Three hundred and ninety three women who had completed one successful pregnancy (para 1) who booked for antenatal care in a single Glasgow hospital completed questionnaires at 20 and 30 weeks gestation and measures of percieved difficulties with the household role and of the frequency of negative feelings about participation in the role were obtained. Risks of preterm birth and low birthweight were associated with the measures of perceived difficulties at 20 and 30 weeks gestation. The association was strongest for the measure taken at 20 weeks where the odds ratio for those experiencing high levels of perceived difficulty were 2.86 (95% CI = 1.05-7.76) for preterm birth and 4.70 (95% CI = 1.53-13.38) for low birthweight. Although the frequency of negative feelings about the household role were strongly associated with the level of perceived difficulties, it was not associated with either preterm birth or low birthweight. The gradients of risk associated with problems in the household role were maintained within categories of socio-economic indicators (social class, housing tenure and low income) and self-reported smoking, suggesting that the risks are independent of these other risk factors. The findings reported are consistent with the hypothesis that psychosocial difficulty in the household role represents a risk factor for preterm birth and low birthweight and suggest that smokers who experience psychosocial problems may be a particular risk.